We’re aware of widespread challenges many of you working in NHS Talking Therapies services across England are facing. Pay is lower than that of other psychological therapist colleagues working in the same services and with the same cohort service users.

This inequity in pay and conditions is wrong and not supported by NHS England.

To support you, if you wish to challenge this pay inequity, we’ve collated resources and evidence that might be of use. The resources demonstrate why all practitioners delivering high intensity therapy in NHS Talking Therapies services should receive the same pay and conditions.

These resources may assist you in discussions with service leaders, your colleagues, unions or us as your professional body.

Context

NHS Talking Therapies for Anxiety and Depression services is the main way adults in England access psychological therapies through the NHS.

The service is based on a stepped care model. Low intensity CBT interventions are offered at Step 2. A range of high intensity psychological therapies, including CBT, Person Centred Experiential Counselling for Depression (PCE-CfD), Dynamic Interpersonal Therapy (DIT), Interpersonal Therapy (IPT) and Couples Counselling for Depression (CCfD), are offered at Step 3.

A key feature of a good NHS Talking Therapies service, as set out by NHS England in the Talking Therapies for Anxiety and Depression manual, is ensuring a choice of interventions are made available to service users so they can co-create their care plans.

The case

NHS England says that all the interventions recommended for use at Step 2 and at Step 3 are equally effective for use at their respective step. A person is offered an intervention based on their individual choice, not because one is better than the other. This is made clear in the NHS Talking Therapies manual.

NHS England also clearly states, in both the NHS Talking Therapies manual and NHS England’s Agenda for Change pay scales, that all low intensity practitioners delivering interventions at Step 2 are considered equal to each other and should be paid as such. It also emphasises that all High Intensity Practitioners delivering interventions at Step 3, including counsellors, psychotherapists and CBT therapists, are considered equal and should be paid equally.

NHS England’s Agenda for Change pay scales sets out that trainee ‘High Intensity Practitioners’ should be paid at a Band 6 and qualified ‘High Intensity Practitioners’ should be paid at Band 7.

NHS England defines what a trainee High Intensity Practitioner and a qualified High Intensity Practitioner is in the NHS Talking Therapies manual. An example of a trainee is a practitioner working towards the completion of the recognised top up training for one of the NHS Talking Therapies high intensity modalities, or required professional membership level. They become qualified high intensity therapist once the practitioner meets criteria set out in the NHS Talking Therapies manual.

In addition, the current Psychotherapeutic Counselling NHS Training Pathway pilot has established clear precedent for non-CBT practitioners working in NHS Talking Therapies services to be paid in line with their CBT colleagues. The pilot aims to provide a core psychotherapeutic counselling training and embedded NHS Talking Therapies qualification in either person centred experiential counselling for depression, dynamic interpersonal therapy or couple’s counselling for depression,

To support achieving pay equity across all NHS Talking Therapies services, NHS England has published Band 7 job description exemplars for High Intensity Practitioner roles within NHS Talking Therapies services. These exemplars provide examples of Band 7 practitioner role descriptions and what qualifications and competences roles would typically require. These exemplar job descriptions are linked to in the resource section below.

How we can support 

We can provide information and support to counsellors and psychotherapists affected by pay inequity where the issue poses a reasonable risk to the continued provision of services to the public and where the issue affects the profession, rather than an individual practitioner. Such as providing resources like this support pack.

But as a charity there are limitations to the personal support we’re able to give individuals, when it relates to their specific employment circumstances.

We’d encourage you to get in touch with your trade union representatives to discuss your personal case. We’re happy to provide information and resources to unions and union representatives to help them best support you.

Read and download resources

Quote from Dr Adrian Whittington

Dr Adrian Whittington, National Clinical Lead for Psychological Professions at NHS England, has provided support and clarification to this being the case from NHS England. He says:

"We [NHS England] support that all high intensity practitioners working within NHS Talking Therapy Services who have completed a NHS Talking Therapies qualification (PCE-CfD, IPT, DIT, CBT etc) should be paid at a Band 7 – irrespective of the high intensity modality they practice and that those who are working towards an IAPT qualification and don’t yet meet all the requirements of practitioners set out in the IAPT manual are paid at Band 6."

[supporting information provided by Dr Whittington specifically for this briefing addressing pay equity in NHS Talking Therapies services, June 2023].

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